Tuesday, November 18, 2014

In the last sixty-five years or so, psychotropic (mind altering) drugs have had a profound impact on America and on Portsmouth in particular. The history of psychotropic drugs, at least in Portsmouth, can be divided for rhetorical purposes into roughly five overlapping stages. Those could be called, based on the psychotropic drug that predominated in each: (1) the chlorpromazine (2) the meprobamate; (3) the benzoylmethylecgonine; (4) the paramorphine; and (5) the buprenorphine stages. Except for the anti-psychotic chlorpromazine, which was marketed in the U.S. as Thorazine, all of these drugs are addictive to varying degrees. However, the withdrawal symptoms associated with Thorazine can be similar to withdrawal from addictive drugs.

The first important psychotropic
drug in America was the powerful anti-psychotic chlorpromazine, marketed in the United States as Thorazine.
First synthesized in 1950, chlorpromazine revolutionized the psychiatric care
of psychotics, particularly schizophrenics. According to Wikipedia, “The introduction of chlorpromazine during the 1950s into clinical use has been described as the single greatest advance in the history of psychiatric care, dramatically improving as it did the prognosis of patients in psychiatric hospitals worldwide.” In the 1950s, I worked as a psychiatric aid
in mental hospitals in Massachusetts and Connecticut and witnessed firsthand the dramatic
improvement in the treatment of patients brought about in large
measure by chlorpromazine.

I began as a psychiatric
aid at Boston State Hospital where I
assisted in the use of hydrotherapy and electro-shock to treat psychotic patients. But just several years later I worked as an aid in a private mental hospital in Hartford delivering
chlorpromazine to more tractable patients. In the 1960s and 1970s, because
of the “tranquilizing” effect of chlorpromazine
on psychotics, many public mental hospitals closed down, as Boston State
Hospital did in 1979 and as the Receiving
Hospital did in in Portsmouth decades later. Because of advances in anti-psychotic medications and the subsequent deinstitutionalization of
mental patients, today people are walking the streets in American cities, including Portsmouth, who would have been institutionalized in the 1950s. Diversity was not a virtue in the '50s, when there was little tolerance for deviation in sex, politics, or social behavior.

The Meprobamate (tranquilizer) Stage

Above: The 3D molecular structure of the psychotropic diazepam (Valium)

The success of Thorazine
helped set the stage for the synthesizing
of milder psychotropic drugs for the treatment of patients with emotional
rather than mental problems, patients who were classified as neurotic rather
than psychotic. The first tranquilizer, meprobamate, was marketed as Miltown in
1955. “Thorazine—which offered the first effective treatment for schizophrenia—had revolutionized the treatment of institutional psychiatry,” Newsweek reported in 2009, “and Miltown seemed to offer a pharmaceutical counterpart to the management of everyday nerves.” People of a certain age will
remember what could be called the Miltowning
of America in the late 1950s. To quote Wikipedia again, “Launched in 1955, [Miltown] rapidly became the first
blockbuster psychotropic drug in American history, becoming popular in
Hollywood and gaining notoriety for its seemingly miraculous effects.” The pharmaceuticals
that developed them usually touted the “miraculous effects” of new drugs, which was the case with meprobamates.
The harmful
side effects were downplayed if not denied entirely. Just as the tobacco
industry covered up the carcinogenic risks
of tobacco, the pharmaceuticals
downplayed the addictive nature of tranquilizers.

Miltown was
followed by Librium and then Valium
(diazepam), which, after it was introduced in 1963, became the
most widely used tranquilizer in the
world. Valium was prescribed for
everything from phobias to depression, and from anxiety to restless leg
syndrome. But it became clear over time
that tranquilizers, including Valium, were
addictive, and when used regularly for a long period, became a serious problem.
The withdrawal symptoms that users experienced
when they tried to stop taking Valium were severe. I know a woman in her nineties who was addicted to Valium for
over a half century, with only her
doctors and close relatives knowing that she was. From what I have gathered, the
first prescription drug addicts in
Portsmouth were not long-haired youths but respectable, responsible members of
the community who were victimized by the pharmaceuticals that synthesized meprobamates and by the doctors who overprescribed them.

The Benzoylmethylecgonine (cocaine) Stage

It was illegal drugs such as heroin and meth, and particularly cocaine (benzoylmethylecgonine), that became the drug of choice in Portsmouth for so-called recreational users. One of the consequences of the cocaine stage was that the money it
illegally generated remained in the underground economy. Drug dealing is a cash only business. That's especially the case with cocaine. The on-line National Geographic News, of all soures, reported in 2009 that nine out of ten American bills show traces of cocaine. The traces get there when the bills change hands in a drug deal or when addicts use the bills to snort coke. The coke trade did little for
the chronically depressed economy of Portsmouth. Instead of helping the economy, the money
generated by the cocaine trade created havoc.
Another problem with cocaine, especially crack cocaine, was that too many of the dealers and their customers went to jail or died of
overdoses. The high incarceration and mortality rate was not good for the coke business. If you have a business that caters to customers who end up behind
bars or dead, you do not have customers you can bank on.

As a sign of the
extraordinary pervasiveness of the drug problem in Portsmouth’s cocaine stage,
the son of the mayor, the son of the police chief, the son of a prominent
judge, the son of a prominent lawyer, and the sons and daughters of other
prominent fathers became addicted, with some of those sons becoming dealers themselves. Though more sons than daughters became addicts, the daughters were by no means closeted, for many of the streetwalkers in Portsmouth were hooked on
drugs. Some years ago I talked to an addicted
prostitute on John Street who told me she was related to a bail-bondsman. There
was no escape from drugs no matter what family or which social class or which side of the law you were on, or whether your dad was a criminal or a judge.

During the crack stage, local, state, and
federal governments spent much more money on
than for
addicts, much more money arresting, prosecuting and incarcerating than rehabilitating addicts. There was much more
money to build jails to lock addicts up than there was for clinics to treat them. In 2006, at the tail end of the crack craze, the $12.5
million dollar Scioto County Jail opened for business with the expectation that
if you built it they would come. But with the attrition of crackheads,
the new jail had trouble maintaining
full occupancy. That meant the county was losing money while still having to pay about $350,000 or so annually to service its debt
for the jail.

Jailing addicts for crimes that were both directly and indirectly
related to drugs became a highly
competitive business. The financially strapped Scioto County Jail sought to
have prisoners from other counties’ crowded jails transferred to its
underutilized facility. Under this arrangement, the other counties picked up the tab. The Huntington Herald-Dispatch reported in
2014 that ten Lawrence County prisoners had been incarcerated at the Scioto County Jail in 2013 at an
annual cost of $230,869 to Lawrence
county. When Lawrence county sought to have the empty former youth prison in Franklin Furnace serve as a less expensive backup
to its crowded jail in Ironton, the Scioto County commissioners and sheriff
strongly objected, calling the Lawrence County plan not only unfair and in violation of state statutes but also “stupid.” For competing contiguous
counties to be calling each other names is just one of the indirect consequences
of the drug epidemic in southern Ohio where addiction, at least for law
enforcement agencies, has been a growth
industry. Much of the breaking and entering of homes and automobiles in the
Portsmouth area was done by addicts desperate for money to buy drugs. Incidentally,
many drug-related petty crimes were not
reported to the police during chief Horner’s stewardship, so Portsmouth’s
official crime rate was probably a lot higher than statistics suggested, though
those rates were already quite high.

The Paramorphine (oxycodone) Stage

Above: The 3D molecular structure of the psychotropic drug oxycodone

The oxycodone stage of
addiction in Portsmouth was more profitable than the cocaine stage at least for the pill-mills and
those connected to them. Instead of the illegal cocaine,
heroin, and meth that fueled the cocaine stage, the oxycodone stage was fueled
by a less potent but fairly expensive and widely available psychotropic
prescription drug. The best selling
brand of oxycodone, Oxycontin helped
alleviate pain, including the pain
associated with withdrawal from more potent narcotics, but without
producing the high that addicts crave. What made Oxycontin less potent was its
timed-release formula. The user did not experience its potency all at once but gradually, over time. But the timed-release formula
was far from foolproof. An addict was able
to easily unleash Oxycontin’s potency immediately
by chewing, pulverizing, or liquefying
it, in which forms it could be swallowed, snorted, or injected. Even the addition of nalaxone to produce
nausea when the drug was taken in large
doses did not stop Oxycontin addiction in the Portsmouth area from increasing exponentially.

On 9 April 2011, a New York Times reporter wrote of Portsmouth, “This industrial town was once known for its shoes and its steel. But after decades of decline it has made a name for itself for a different reason: it is home to some of the highest rates of prescription drug overdoses in the state . . .” Things got so bad in the Portsmouth area that Governor
Kasich said publicly that, when it came to pill-mill prescription drug abuse,
“The devil is in control in Scioto County.” One public health official reported
one in ten babies born in Scioto County were addicted. The police chief
reported that more people had died in Ohio from drug overdoses in 2008 and 2009
than had died in the 9/11 World Trade Center attack. What the police chief,
Charles Horner, did not report was that his addicted, drug-dealing son was one
of those responsible for the overdose deaths. I was told by someone in a
position to know that Horner’s son
brazenly dealt drugs in a restaurant directly across the street from the police
station.

Typically, the local media at first turned a blind eye to the pill mills as chief Horner had to his son. In the same
downtown office building and on the same floor as the local radio station WNXT,
one shady out-of-town doctor opened a
pill-mill office with patients from the tri-state region lining up like
customers at the popular DariCreme on
2nd Street. When a veteran WNXT newscaster learned a
pill-mill down the hall had been raided, its existence was news to him.

The doctors who
indiscriminately prescribed and the people who owned and operated the pill-mills
made millions of dollars, and in doing
so gave a boost to the local economy,
but at what a cost. Oxycontin became
so widely used and abused that Portsmouth
became known as the Oxycontin capital of the nation with one Portsmouth doctor reportedly
writing more prescriptions than any other doctor in the country. The Portsmouth pill-mills became so out of
control in their pursuit of profits that
they were finally raided by federal, state, and local federal law enforcement
agencies. Some of the pill-mill owners and doctors were arrested and convicted, bringing a
reduction, though certainly not an end, to Oxycontin addiction in Portsmouth.

The Buprenorphine (Suboxone) Stage

Above: The 3D molecular structure of the psychotropic buprenorphine (Suboxone)

Much more savvy and
public-relations oriented, and much better connected politically, the
counseling centers in the Portsmouth area, were ready to take up the slack
created by the closing of the pill-mills.
While some addicts have been helped by the centers, profits and politics, not the Hippocratic oath
and humanitarianism, have been dominant in
the buprenorphine stage of Portsmouth’s drug
history. The cost of treating addicts in
counseling centers has been paid for primarily by the government and ultimately by the taxpayers through Medicaid and since 2014 by
the Affordable Care Act, which Republicans have dubbed Obamacare. The cooperation
and collusion between pharmaceutical executives,
U.S. government officials, and unscrupulous
professionals, who were involved in a revolving door arrangement, account in part for the success of counseling centers in the
Portsmouth area.

The Counseling Center,
Inc. and the Community Counseling and Treatment Services (CCTS), operate clinics and halfway houses in Portsmouth where what they euphemistically call “clients”
are treated. A key component of that
treatment of addicts now includes the psychotropic drug buprenorphine, of which Suboxone became the most controversial example. Outselling even Viagra,
Suboxone generated $1.5 billion in American sales in 2010. Suboxone was developed
not by an American pharmaceutical but by a British company, Reckitt and Benckiser (RB), that specialized
in health and household products, such as Clearasil and Lysol. The U.S.
government spent $89 million to help RB develop and market Suboxone on the grounds that it was safer
than methadone. Safer? A firefighter whose son became fatally addicted to Suboxone
remarked that the difference between
more potent drugs and Suboxine was like the difference between Budweiser and
Bud Lite, meaning an alcoholic who switched to Bud Light was still a drunk and
an addict who switched from Oxycontin to Suboxine was still an addict. Reckitt and Benckiser
tried to discourage addicts from abusing
Suboxone by adding nalaxone, an “abuse
deterrent,” to it. If addicts crushed and injected Suboxone, the nalaxone was
supposed to produce excruciating pain and nausea, but that apparently was not enough to stop addicts from abusing it.
Suboxone is one of the drugs that has
made overdoses rather than car accidents the leading cause of accidental death in the U.S.

The U.S. government tried
to control the abuse of Suboxone by
allowing only designated doctors to prescribe it and by limiting those doctors
to thirty patients, but that number was
later raised to 100. In spite of these controls, the illegal use of Suboxone
proliferated. In 2011, the number of
emergency room visits resulting from the illegal use of Suboxone were well over 21,000, which
was nearly five times what they had been five years earlier. The doctors who prescribed Suboxone were far
from simon-pure and some of them had
even been law-breakers. Rather than the Hippocratic, they appeared to have taken the hypocrite oath. Their
primary objective was not to help the addicted but to get rich. As reported in
the New York Times (15 Nov. 2013), Dr. Robert L. DuPont, the
first director of the national drug abuse institute, said that at a recent meeting of the addiction medicine
society, “the buprenorphine sessions were all packed with doctors who wanted to
get in on the gold rush.” Too many of the doctors who became Suboxone prescribers did so because they saw it as a
bonanza for their faltering practices. Among them were doctors who had been
sanctioned for drug addiction; or convicted of Medicaid fraud and of smuggling
steroids from Mexico; or of conducting an “excessive number of invasive
procedures”; or of failing to report a case of rape of a pediatric patient and
of having intercourse with patients in
the office. The government’s screening process was clearly lax. In Ohio, it
turned out that nearly 17 percent of the doctors given permission to
prescribe Suboxone had been previously
disciplined by authorities whereas only 1.6 percent of Ohio doctors in general
had been. If it was 17 statewide, it is easy to believe the percentage was even
higher in Portsmouth, one of state’s most addicted cities.

The Treatment Services (CCTS)
recently had its clinics in Portsmouth raided by police. According to channel WNXT,
CCTS owner Paul Vernier and his employees had been engaged in trafficking in
drugs, laundering money, and defrauding insurance companies and the U.S.
government by forging prescriptions. In addition to searching for evidence in
Vernier’s Portsmouth clinics, the police also used a search warrant to look for
incriminating records and papers at his palatial hillside house in West
Portsmouth. The other Portsmouth operation, Counseling Center, Inc., which has
influential friends in the county government and in the state legislature,
continues doing business as usual in Portsmouth. The raiding of Vernier’s clinics removes Ed Hughes’ chief competition. Business for Counseling Center, Inc., with its motto “We believe in miracles,” is prospering and expanding, especially in the historic Boneyfiddle district.

When I began my blog River Vices in 2004, I said Mark Twain felt river cities had more than their share of vices and I thought that Portsmouth was no
exception. I never knew a city that had more religion and less morality than
Portsmouth, which calls to mind Twain’s remark
that “religion began when the first con man met the first fool.” The slogan of Counseling Center, Inc., suggests Hughes might be using the Almighty to cloak his
lucrative business in religion, as Vernier seems to have done by naming a real
estate business he owns Blessed Realty, L.L.C. Blessed are the realtors in spirit for they shall profit from the First Commandment of Portsmouth politics (click here). That reminds me that Tammy Faye Bakker and her convicted televangelist husband Jim Bakker named their profitable non-profit televangelist racket PTL, short for "Praise the Lord!" That's what she used to exclaim tearfully and often on the Jim and Tammy Show, heavy mascara
running down her rouged cheeks. Incidentally, it may not be coincidental that Tammy
Faye turned out to be addicted to Valium. Whether or not Ed Hughes’s Counseling Center turns out to be a
racket, he has become a multi-millionaire, according to Austin Leedom, the dean of Portsmouth's investigative reporters. What I
will explore in my next post is the possibility that Hughes may be addicted not to any of the five drugs discussed above but to the most powerful and pervasive drug in the world. What is that drug? Stay tuned.

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About Me

Retired now, I was born in Boston, Massachusetts, hold B.A. and M.A. degrees in English from Wesleyan U. (Conn.) and a Ph.D. in American Studies from Yale, where I was a Research Associate at the Institute for Social and Policy Studies and a coordinator of a committee that organized international American Studies conferences during the American Bicentennial. From 1989-2006, I taught English at Shawnee State U., in Portsmouth, Ohio, where I was active in the faculty union, the Shawnee Education Association, serving four terms as president. I also served as faculty advisor to the student gay and lesbian group. I have served also as president of the Concerned Citizens of Portmouth and Scioto County, a community action group.
My scholarly interests have focused on the American Dream: the Myth and the Realities.
I can be reached at rforr1@roadrunner.com
A selection of my poems can be found at http://xpalidosis.blogspot.com The original contents of all blogs on this site are copyrighted @.